28TH MEDICAL GROUP SGSL (NPI# 1699872440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699872440 |
| Entity Type | Organization |
| Organization Name | 28TH MEDICAL GROUP SGSL |
| Other Organization Name | ELLSWORTH PHCY 28TH MDG |
| Practice Address |
2900 Doolittle Dr Ellsworth Afb SD 57706-4821 |
| Practice Telephone | 6053853250 |
| Practice Fax Number | 6053853679 |
| Mailing Telephone | 6053853250 |
| Mailing Fax Number | 6053853679 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-11-18 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2094271 | 01 |
| Other Name | Type Code |
|---|---|
| ELLSWORTH PHCY 28TH MDG | Doing Business As Name - Organization |
| Street Address |
2900 DOOLITTLE DR |
| City | ELLSWORTH AFB |
| State | SD |
| Zip Code | 57706-4821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083607535 | Michael Scott Bogaard | Optometrist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2005-08-30 |
| 1023648128 | Sereirath Som Hart | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2020-01-17 |
| 1811459662 | Anthony David Delcorral | Dentist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2019-04-02 |
| 1942766746 | Joseph Minette Stanfill | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2019-02-16 |
| 1275016214 | Elizabeth Gunnell | Counselor | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-09-14 |
| 1760989933 | Jeffrey Moran | Pharmacist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-04-12 |
| 1851898191 | Stephen Beals | Pharmacist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-04-12 |
| 1205330651 | Ariel Hough | Dentist | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2018-03-21 |
| 1629576491 | Mario Luis Recupido IIi | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2018-01-26 |
| 1205342664 | Sheila Renee Johnson | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2017-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801307202 | Patrick David Jones | Physician Assistant | 28th Mdg/sggp, 2900 Doolittle Dr., Ellsworth Afb, SD 57706 | 2017-10-12 |
| 1770736522 | Amy Marie Kubal | Dietitian, Registered | 2450 Risner Drive, Ellsworth Air Force Base Health and Wellness Center, Ellsworth Afb, SD 57706 | 2008-10-24 |
| 1275057754 | Adrianne Rae Littles | Military Health Care Provider | 2900 Doolittle Drive, Ellsworth Afb, SD 57706 | 2017-07-27 |
| 1467501874 | Tasha Dee Standing Soldier | Pharmacist | 2900 Doolittle Drive, 28th Medical Group, Ellsworth Afb, SD 57706 | 2007-01-09 |
| 1326286899 | Michelle Andaya Ziegler | Physical Therapist | 532 Tallent Ct, Ellsworth Afb, SD 57706-1717 | 2009-01-21 |
| 1528330081 | Marryanne Allen | Nurse Practitioner | 105 Red Cloud Ct, Ellsworth Afb, SD 57706-1724 | 2012-01-30 |
| 1710201553 | Ivan Vicente | Military Health Care Provider | 433 Black Elk Ct, Ellsworth Afb, SD 57706-1847 | 2010-03-23 |
| 1831539642 | Brendan Robert Cleary | Pediatrics | 28th Medical Group, Ellsworth Afb, 6000 Doolittle Drive, Rapid City, SD 57706-1873 | 2013-06-26 |
| 1922094671 | Scott Anthony Jones | Physical Therapist | 2450 Risner Dr, Ellsworth Afb, SD 57706-4704 | 2005-09-27 |
| 1174703144 | Michelle Renaee Haleck | Dietitian, Registered | 2450 Risner Dr, Ellsworth Air Force Base, Ellsworth Afb, SD 57706-4704 | 2007-11-07 |
| Find all providers in zip 57706 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710390570 | 28th Medical Group Sgsr | Military/U.S. Coast Guard Pharmacy | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2014-06-09 |
| 1023091642 | 28th Medical Group | Military/U.S. Coast Guard Pharmacy | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2005-11-29 |
| City | ELLSWORTH AFB |
| Zip Code | 57706 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.